Friday, December 7, 2007

Out with the Reps, In with the Internet

A while ago, us critics of the medicine-Pharma interactions thought that we might prevail if we could only convince physicians that their cozy interactions with drug reps were not as "back room" as they thought but actually were occurring in a fishbowl--that patients and medical students, for instance, were seeing all this happen and not liking what they saw.

Maybe it worked.

The AP reports that the industry is now intent on scaling back its face-to-face rep action in favor of selling over the Internet:

There are a number of factors at work--the drug rep arms race that admittedly, to most industry insiders, flooded the market with too many reps; the rising costs of marketing coupled with fears of lower profits as blockbusters go off-patent; and the times, with many of us staying away from the mall so that we can shop on Amazon and eBay.

The article from AP states that docs in many cases refuse to see reps at the office, but are willing to spend 10 minutes talking with a rep by phone as the rep directs the doc to an Internet site with glitzy video presentations about new drugs. The article is silent on the gift angle. Most home computers, last I heard, are not set up to dispense gourmet dinners, or even pens and mugs; so the doc cannot get rewarded as per the old-fashioned rep visit. I believe that e-mail or mail vouchers for various benes have been used in connection with Internet marketing, but this particular story provides no details, and I'd like to hear more from others in the know.

Is this a good or bad development? If, by chance, the gift element has been removed (which I doubt), then maybe things are better. But we still have docs using commercially biased sources of information instead of doing some independent thinking and searching for more reliable data, which cannot be good for patients.

I'd dare to argue that internet information about a particular medication or disease state for that matter is much more reliable than from a rep. from the maker of such a med. Bias is removed. Education, while likely embellished, is more solid, considering most drug reps have no real experience or medical training (but do have looks and personality, yet I'm unknown of any correlation between these traits and the well being of your patients). Also, pharma internet sites likely will have links to objective sources related to the class of meds exploring and the disease state for which it treats. The health care provider will experience less interruption from a drug rep, as the provider can seek desired info at a time frame according to thier own discretion. An added benefit would be for a provider to request samples on the interet, which few pharma companies have offered so far. Of course, inducements would be tough to come by, followed by the coerced reciprocity and/or extortion, but a provider can probably do without that anyway.

One of the main functions of pharmaceutical representatives is to provide free samples to doctor’s offices presently instead of authentic persuasion, and these samples in themselves cost billions to the pharmaceutical industry. Yet arguably, samples are the most influential tool in influencing the prescribing habit of a health care provider. Let me be clear on that point: Its samples, not a representative, who may be the top influencer of prescribing habits.

Yet considering that drug promotion cost overall is approaching 20 billion a year, combined with about 5 billion spent on drug reps themselves, what if there is another way for doctors to get free drug samples, which is what they desire for their patients to initiate various treatment regimens? What if prescribers could with great elation avoid drug reps entirely?There is, actually, a way to do this, but it is limited. With some select, smaller pharma companies, doctors have the ability to order samples by printing order forms on line for certain medications through certain web sites associated with the manufacturers of these samples. Some examples are such medications that can be ordered in this way are keflex, extendryl, and allerx. Possibly several more can or are available to prescribers in this way. Others, however, cannot be acquired by this method.

So in some situations, a doctor can go on line, print off a sample order form, fax it into a designated fax number after completion of the form, and the samples are shipped directly to the doctor’s office with some products thanks to their manufacturers who provide this avenue. There is no review of the doctor’s prescribing habits. No embellishments from reps actually sounds pretty good.

Usually, this system is available for those smaller companies with very small sales forces to compensate for what may be vacant territories, but can be applied to any pharmaceutical company who, upon discretion, could implement such a system.Now, why is this not done more often? Apparently, it is legal to obtain samples in this manner. If samples are the number one influencer of prescribing habits, why spend all the money on reps to deliver samples personally? It’s worth exploring, possibly, since the drug rep profession has evolved into those who become UPS in a nice suit.

Think of the money that could be saved if more pharma companies offered samples to doctors in this manner. Furthermore, additional benefits with this ideal system are that there is no interruption of the doctor’s practice. And again, there is no risk of bias presented to the doctor by a rep, as they would avoid contact with reps if they order samples through this way- to have the samples directly to be shipped to their office.

When samples are shipped to doctors’ offices in this manner, prescribing information of the particular med is included with the samples shipped. Doctors can order and utilize samples according to their discretion, and would be free of interference from the marketing elements of pharmaceutical corporations. Patients benefit when this occurs.Considering the high costs associated with the pharmaceutical industry, having samples shipped directly to doctor’s offices should be utilized more than it is presently- regardless of the size of the pharmaceutical company. Something to think about as one ponders cost savings regarding this issue.

“The new source of power is not money in the hands of a few but information in the hands of many.”---- John Naisbitt